WeNatal Ask The Expert: Kelly LeVeque On Preventing Postpartum Depletion

1. Q: What are your tips to prevent postpartum depletion?

Postpartum can last a really long time. It depends on how long you’re breastfeeding and how you’re feeling while you’re breastfeeding. I don’t think people realize that breastfeeding takes up about 30% of your energy stores, where your brain only takes 20% and your heart takes less than that. So your equivalent is walking seven miles a day. It’s a lot of energy. 

Some people will say it’s 500 calories, but the calories that we’re consuming that replace that and the nutrients that we need to deliver to our child include everything from B vitamins to all those fat soluble vitamins, a high amount of protein, sugar, stem cells, and immune factors. It is influenced by how we eat and more about how our body will break it down. When you think about it as fuel, you have to fuel a little bit differently. What does 500 calories look like? Is it a lactation cookie that doesn’t have those fat soluble vitamins or the protein that your body needs? Because if it is, no shade, but you will see your body give up those nutrients from somewhere else- i.e. the skeletal muscle, organ weight. We want to look at those 500 calories in the most nutrient dense way to replenish what we lose. 

I’ll say as someone who with my second pregnancy ended up getting iron infusions and I eat red meat twice a week or now it’s like everyday or every other day. But it takes on average 6 to 8 months for iron levels to come back up. So it would be important for you, if you are pregnant, to get your iron and ferritin levels up so that you can understand where you’re at, because iron delivers oxygen and nutrients to your entire body. One of the number one causes of fatigue in postpartum is iron deficiency, not anemia but suboptimal iron. 

Q: What are your tips to support breastfeeding and exhaustion?

What’s crazy is that 64% of women in postpartum feel fatigued, and the two predominant causes of that are dehydration and suboptimal iron levels. I would say get an electrolyte that you like. You want to make sure that you have sodium, magnesium, potassium in that blend. I do like Element- I’m an investor, full disclosure, but I like it because it was the first sugar free electrolyte that I thought was just enough sodium to retain the water I was drinking so that it wasn’t coming right out of me in the I see a major impact on on breastmilk supply.

The hard part is when you look at recommendations for sodium, you’ll see that it’s only 2 grams or less. But we see if someone is active or if you eat a whole food diet that’s not processed, you will excrete a lot of your sodium. So in fact, 5 milligrams can be the sweet spot when they actually aggregate for that in research. This causes people to get really afraid about the sodium level and high blood pressure.

But a lot of the time, the sodium in our diet is contributed from processed foods.  It’s a unique time where you care a lot about what you’re eating because you’re either trying to make a baby, you’re making a baby, you’re feeding a baby through your breastmilk, or you’re needing to fuel yourself to keep up with however many times they’re up in the middle of the night. 

Most of the time our sugar cravings are related to being dehydrated or having even like low blood sugar. And having a crash will obviously impact that.

Q: Can we get all of our nutrients from food? 

We would all hope that you would be able to get all of your nutrients from food… but if you’re not so strategic, you would have to understand by getting your blood drawn prior to getting pregnant where your levels are, then you’d have to be strategic about food cycling and getting liver into your diet consistently as like a multivitamin, really strategic about your red meat intake, probably really strategic about wild fish intake.

The reality is, a lot of us don’t have the time to make what we eat our full time job. Even though it is my full time job, I don’t even do that. It’s about filling in the gaps when it comes to taking a prenatal or a supplement. And even all the Functional MD’s that I work with from Chris Kresser to Will Cole to Dr. Mark Hyman are recommending supplements to optimize basic levels. 

There are certain people that maybe don’t have the microbes to convert the nutrient in their gut or make a bioavailable or they don’t have the stomach acid that breaks it down. There’s so many things at play when it comes to digestion and also what they’re eating and where they’re sourcing it from.

Nutrition is totally dependent on the soil. Produce today isn’t growing in the wild and nutrient dense soil- we’re going to have depletion or suboptimal levels in the food that we’re eating.

Q: Can we talk about nutrients we may be missing and what we may need to supplement?

The critical ones that come to mind for me would be making sure that you’re having an iron rich source of protein only because if/when you’re pregnant, iron levels are so important. It’s one of those nutrients of concern for the NIH and if you don’t eat meat, you would want to get a blood test and you’d want to supplement with an iron supplement only because that’s irreversible cognitive defects. Vitamin C with iron rich foods is going to increase bioavailability. But knowing your levels is important and most of us who go to an OB, they’re going to do a blood draw- you can always add things if you need that, but iron is one of those I’d pay close attention to. 

I think vitamin D (most people are deficient) and DHA, are also so critical. Supplementing with DHA which is a long chain omega-3 fatty acid, we all know it can improve fetal development and can support fertility.

Like I mentioned before, the most important thing you can do is own your power. If I can’t control this and I don’t really know what’s going on, what can I control? Having that foundation of nutrition through a supplement is so important. Unfortunately, in today’s day and age, I think you should do it as insurance.

Q: What would be an optimal lunch and breakfast in your mind? (or what do you typically eat during postpartum?)

I had iron infusions when I was pregnant with Tashan.I care very deeply about what I eat and I would say that I have always eaten animal protein, but it’s amazing how much you give away when you’re breastfeeding. And for Sebastian, my oldest, it was 18 months of breastfeeding rolling right into my second pregnancy. What I noticed was way more symptoms this time around- like more nausea, more fatigue. 

So this might scare you a little bit, but what I’m eating right now in postpartum with my third son is what I call my Fab 4 Smoothie. Which is protein powder, I have protein powder as you heard, a vegan and a beef, but I put protein powder in there with either water, unsweetened coconut or almond milk, a source of healthy fat (maybe ¼ or ½ small avocado) and then and and then I do a fiber source. I really like psyllium husk right now, and then leafy greens for all those antioxidants.

Because of my experience with postpartum, with Sebastian and then also just feeling pretty depleted with feeding Tashan, I will probably have about 3 ounces of grass fed ground beef to five or 6 ounces of grass fed ground beef on the side of that. I am taking this very seriously and here’s what I will tell you…

What I’ve noticed is my energy levels are just better than they’ve been since before I was pregnant with Sebastian. My body’s responding really in a positive way in regards to feeling the strength- and I’m not cross-fitting or lifting heavy. I am like zone defense with my husband and three kids under 5 right now and running a full business. It is like how do we negotiate for personal, personal time to work out right now? Otherwise I’m like throwing kids in a stroller and being like – this hill counts so it is a little bit not the norm right now.

I am fully having a side protein on top of that and I am not looking at the calories. I am looking at hitting 40 to 50 grams of protein when I break my fast.

There has been a history in the last 15 to 20 years of even some of our favorite friends saying that we should eat meat as a side or portion of our meal. But the reality is when it comes to nutrient density, ounce for ounce, it has your fat soluble vitamins, water soluble vitamins, minerals – you just can’t compete with red meat.

Getting strategic with it [red meat] has just been an absolute game changer for me. When it comes to recovery, I would say I’m sleeping better. I think we’ve normalized like massive amounts of hair loss and postpartum as women and I think we’re under eating. I think we’re nutrient depleted. 

Q: If you don’t eat red meat, is there an option that you can supplement with? 

Well, I think you can look at other sources of proteins that may deliver that. I would say, oysters, shellfish which is going to give you like all those minerals. You can look at wild fish like salmon, which is going to give you that long chain Omega-3s and the protein levels. You’ll get some Vitamin D, too. You could also do a desiccated liver capsule if you’re open to that because you’re going to get all those nutrients.

I did desiccated liver capsules a little bit because of the nutrient density there and the bioavailability there and there’s some good companies that do that.

Q: How do you balance it all?

I’ve always been a proponent of meals over snacks and really sitting down and not being afraid to feel like an athlete. Like we ARE athletes when you’re pregnant, breastfeeding or momming. You are required to handle so much between your eyeballs and emotionally, stress wise, schedule wise you name it. We are holding the walls up and the roof up at the same time and so don’t forget about you. 

In reality, I’m never going to be able to really take care of myself first. But if I’m doing it at the same time or what I’m serving my kids, it’s also serving me, I can get to that 70% of the time. I think that that’s enough. And so if people want to love you, make you meatballs, say yes to the help and throw them in your freezer! 

Making sure that you have easy things to add like bone broth, collagen and glycine and get some protein in your diet. There’s so much we can do, but it can be overwhelming. So find what’s right for you. Just think about the other ways that you can add those nutrients into your life, because there is nothing like feeling fueled and taking it as seriously as you deserve.

Q: Why is it so important to manage your blood sugar, whether you’re trying to conceive, pregnant or postpartum? 

Elevated levels of insulin are going to have an effect on egg quality and sperm quality. And we know that dysregulated blood sugar and insulin issues are linked to the development of polycystic ovarian syndrome, which is one of the number one issues with fertility. And so when we see this, we also can’t forget the fact that dysregulated blood sugar is a stress on the body, right? It doesn’t mean that our blood sugar needs to be flat.

Being able to eat meals that support blood sugar balance is going to be important for sustained energy levels. It’s about making smart food choices. Let’s say you wake up; you’re helping your kids get ready, there happens to be a piece of toast on the table. You grab it with your coffee and you eat the toast and that’s all you have. However, that is a processed form of carbohydrate that your body will digest pretty quickly and your blood sugar is going to rise. What’s going to happen is your blood sugar is going to flood with insulin, and insulin is going to support that glucose to be put away in your body, whether that’s in your liver or your muscles. Then a crash is going to happen. On average our blood sugar goes up 90 minutes and comes down 90 minutes. But depending on what we eat, that blood sugar spike will go up hard and fast. Making a choice to have something that has more fiber in it is going to slow down the digestion of that meal so that that ride is slower and that crash is gradual. 

There are hacks out there to support blood sugar balance but I think the best tip is understanding the science and understanding that protein is going to have little to no effect on your blood sugar, fat is going to have no effect on your blood sugar and fiber is going to support the slowing of the digestion of that meal.

When you are putting a plate of food together you want to think, what is my protein source? Either a plant based source, or an animal based protein- so red meat or salmon tacos. Then you have your guacamole- there’s your healthy fat. It’s also loaded with fiber, so it’s slowing down your digestion. Let’s add some lettuce, and tomatoes -there’s some color right there, greens or veggies deep in color that’s going to add all those antioxidants to fight that oxidative stress. Then you think… tacos are way better on tortillas, right? Then you think, how can I understand if the tortilla is the carbohydrate and it is a processed form of carbohydrate that will drive up my blood sugar, how do I make a choice that feels balanced to me and my family? That may be one corn tortilla or maybe you’re choosing a lower carb tortilla like an almond flour tortilla where the net carbohydrates allows for two without you feeling like I’m riding a high and crashing down. Or you can make a bowl and skip the tortilla all together. 

The freedom comes when you understand the science. You can understand the science by tracking it with a continuous glucose monitor. The education there and understanding there gives you freedom of flexibility! I used to say that if low carb is good, no carb is the best, but that’s actually a stress on the female body and it can be a stress for our fertility, trying to get into ketosis and feeling that stress, it can be hard on us and hard on our fertility.

Q: Does it matter the order you eat?

Yeah it does! Protein, fat, fiber, greens, but the protein being slowest to digest and the hardest to digest. So when you also put the protein first you eat less of the carbohydrates. The protein is going to be the most satisfying thing on your plate-  it’s going to start to turn off hunger cues. In my first book that came out in 2017, I talked about eight hunger hormones and protein is regulating more than half of those.

What makes us feel full is the nutrients, which is kind of interesting. You have nerves that innervate your intestines that are actually looking for specific amino acids and fatty acids that are essential. When we’re eating those things, we’ll start to feel full. The other things that can make us feel full are fat and then the stretching of our stomach. This is where, say you are a person who grabs a protein bar and you’re like it’s so much protein but you’re hungry 90 minutes later… that same amount of 20 grams of protein and the 10 grams of fiber and the five grams of fat in that bar could literally be a meal this big.

Q: Can you share your tips and tricks for blood sugar regulation?

There has been some popularized research on acetic acid, which is the component inside of apple cider vinegar, which can blunt a glucose spike. I wouldn’t say that it is your free ticket to Ben and Jerry’s, but anything that has acetic acid, fermented vinegar, like balsamic vinegar, apple cider vinegar, etc can help. 

Adrenaline and cortisol can cause a blood sugar spike. Your body thinks that you need energy and you’re fleeing from a bear or a lion and it’s going to react by the energy that you need (like how I’m presenting today). I really like to either have caffeine with a meal or with a fat to slow down the absorption and the speed of that caffeine or even consider like 1/2 calf because you’ll probably get the hit that you need anyways. 

One of the things that I do in my espresso machine is I do a water process decaf and a regular together to just lower my caffeine intake because it is my drug of choice. And if you’re ever in a position where you like to do something fasted, (for me I like doing a podcast fasted). But it can be a real energy drain. So think about how you feel after that getting a good source of protein, fat, fiber. I live and die by the fat for a little bit. I do for my kids, meals for everybody, because I just want everybody to be as balanced as possible. Sometimes, the meltdown is my fault. But we’ve all been there.